Endotracheal tubes: old and new.
نویسندگان
چکیده
The development and evolution of the endotracheal tube (ETT) have been closely related to advances in surgery and anesthesia. Modifications were made to accomplish many tasks, including minimizing gross aspiration, isolating a lung, providing a clear facial surgical field during general anesthesia, monitoring laryngeal nerve damage during surgery, preventing airway fires during laser surgery, and administering medications. In critical care management, ventilator-associated pneumonia (VAP) is a major concern, as it is associated with increased morbidity, mortality, and cost. It is increasingly appreciated that the ETT itself is a primary causative risk for developing VAP. Unfortunately, contaminated oral and gastric secretions leak down past the inflated ETT cuff into the lung. Bacteria can also grow within the ETT in biofilm and re-enter the lung. Modifications to the ETT that attempt to prevent bacteria from entering around the ETT include maintaining an adequate cuff pressure against the tracheal wall, changing the material and shape of the cuff, and aspirating the secretions that sit above the cuff. Attempts to reduce bacterial entry through the tube include antimicrobial coating of the ETT and mechanically scraping the biofilm from within the ETT. Studies evaluating the effectiveness of these modifications and techniques demonstrate mixed results, and clear recommendations for which modification should be implemented are weak.
منابع مشابه
Safe Use of Flammable Endotracheal Tubes During Anesthesia for Laryngeal Laser Surgery-Report of 1024 Cases and a Brief Literature Review
Introduction: One of the major concerns in laryngeal laser surgery is the risk of airway fire. The introduction ofwrapped tubes and metal tubes has reduced the fire hazards. However, these tubes are expensive and do not provide convenient access to the surgical field. There are few laboratory studies addressing the resistance of polyvinylchloride tubes against ignition in the given circum...
متن کاملEvaluation of a new thin-walled endotracheal tube for use in children.
Conventional endotracheal tubes have high intrinsic resistive properties due to their high outer-to-inner diameter ratio. This has significant disadvantages in the treatment of the small neonatal or pediatric patient as work of breathing increases with decreasing internal radius. Diagnostic and therapeutic procedures, including suctioning, may be very difficult in patients with small endotrache...
متن کاملبررسی عفونت بیمارستانی در NICU بیمارستان طالقانی، سالهای 1380 و 1381
Background : Nosocomial sepsis continues to be a significant cause of mortality in neonatal intensive care unit (NICU). Various interventional policies have been adopted to reduce its incidence. This study was designed to investigate the role of preventive strategies to bring down the incidence of nosocomial sepsis in the NICU. Materials and methods : The NICU was moved to a new location in 200...
متن کاملExchange of orotracheal tubes in a patient with difficult airway and hiatus hernia.
To the Editor: A 23-yr-old man (height approximately 155 cm, weight 38 kg) with acute respiratory failure required exchange of endotracheal tubes. He had spastic cerebral palsy at two months of age, had had spastic quadriplegia, mental retardation, severe scoliosis and repeated regurgitation and pneumonia due to hiatus hernia. The head and neck were fixed in a flexed position and the interincis...
متن کاملPediatric cuffed endotracheal tubes: an evolution of care.
PURPOSE To examine the history of pediatric endotracheal intubation and the issues surrounding the change from uncuffed endotracheal tubes to cuffed endotracheal tubes, including pediatric airway anatomy, endotracheal tube design, complications, and safety concerns. METHOD Review of the literature. CONCLUSIONS Although the use of cuffed endotracheal tubes in infants and children remains a t...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Respiratory care
دوره 59 6 شماره
صفحات -
تاریخ انتشار 2014